THE CENTER FOR PROSTATE HEALTH

Learn About Prostate Cancer – Know your Treatment Options

What is the prostate?

The prostate is a gland in the male reproductive system. The prostate makes and stores a component of semen and is located in the pelvis, under the bladder and in front of the rectum. A healthy prostate is about the size of a walnut. Because of the prostate's location, the flow of urine can be slowed or stopped if the prostate grows too large.

What is prostate cancer?

Prostate cancer forms in the tissues of the prostate. Except for skin cancer, cancer of the prostate is the most common malignancy in American men. In most men with prostate cancer, the disease grows very slowly. The majority of men with low-grade early prostate cancer (which means that cancer cells have been found only in the prostate gland) live a long time after their diagnosis.

Who is at risk for prostate cancer?

An important risk factor is age; more than 70% of men diagnosed with this disease are over the age of 65. African-American men have a substantially higher risk of prostate cancer than non-Hispanic and Hispanic white men. Genetic factors also appear to play a role, particularly for families in which the diagnosis is made in men under age 60. The risk of prostate cancer rises with the number of close relatives who have the disease.

What are the symptoms of prostate cancer?

Prostate cancer often does not cause symptoms for many years, but when symptoms do occur, they may include urinary problems such as:

Not being able to urinate

Having a hard time starting or stopping the urine flow

Needing to urinate often, especially at night

Weak flow of urine

Urine flow that starts and stops

Pain or burning during urination

Other symptoms may include:

Difficulty having an erection

Blood in the urine or semen

Frequent pain in the lower back, hips or upper thighs

These can be symptoms of cancer, but more often they are symptoms of non-cancerous conditions. It is important to check with a physician.

Can prostate cancer be found before a man has symptoms?

Yes. Two tests can be used to detect prostate cancer in the absence of any symptoms. One is the digital rectal exam (DRE), in which a doctor feels the prostate through the rectum to find hard or lumpy areas. The other is a blood test used to detect a substance made by the prostate called prostate-specific antigen (PSA). Together, these tests can detect many prostate cancers that have not caused symptoms.

Due to the widespread implementation of PSA testing in the United States, approximately 90 percent of all prostate cancers are currently diagnosed at an early stage, and consequently, men are surviving longer after diagnosis.

How reliable are the screening tests for prostate cancer?

Neither of the screening tests for prostate cancer are perfect. Most men with mildly elevated PSA levels do not have prostate cancer, and many men with prostate cancer have normal levels of PSA. Also, the DRE can miss many prostate cancers. The DRE and PSA tests together are better than either test alone in detecting prostate cancer.

How is prostate cancer diagnosed?

The diagnosis of prostate cancer can be confirmed only by a biopsy. During a biopsy, a urologist removes tissue samples, usually with a needle. This is generally done in the doctor's office with local anesthesia. Then a pathologist checks for cancer cells.

Prostate cancer is described by both grade and stage:

Grade describes how closely the tumor resembles normal prostate tissue. One way of grading prostate cancer, called the Gleason system, uses scores of 2 to 10. The higher the score, the higher the grade of the tumor. High-grade tumors generally grow more quickly and are more likely to spread than low-grade tumors.

Stage refers to the extent of the cancer. Early prostate cancer (stages I and II) is localized. It has not spread outside the gland. Stage Ill prostate cancer, often called locally advanced disease, extends outside the gland and may be in the seminal vesicles. Stage IV means the cancer has spread beyond the seminal vesicles to lymph nodes and/or to other tissues or organs.

How is localized prostate cancer treated?

Three treatment options are generally accepted for men with localized prostate cancer: radical prostatectomy, radiation therapy (with or without hormonal therapy), and surveillance (also called watchful waiting). Not all physicians offer every treatment option. South Nassau offers the full range of treatment options and recommends that you discuss each of these options with your physician before making a determination.

Radical Prostatectomy is a surgical procedure to remove the entire prostate gland and nearby tissues. Sometimes lymph nodes in the pelvic area are also removed. Radical prostatectomy may be performed without causing damage to the nerves needed for an erection. However, nerve-sparing surgery is not always possible. Possible side effects of surgery can include incontinence (inability to control urination) and impotence (inability to achieve erection).

da Vinci® prostatectomy is a robotic-assisted minimally invasive surgery that is performed with the assistance of the da Vinci Surgical System. The da Vinci Surgical System enables surgeons to operate with unmatched precision and control using only a few small incisions. Side effects of traditional open surgery, such as incontinence and impotence, may be reduced when da Vinci is used. The procedure is performed laparoscopically.

Dr. David A Silver is the Director of Urologic Oncology at South Nassau. For more information on da Vinci Surgery, you may contact Dr. Silver at 516-632-3350 or visit www.southnassauroboticsurgery.org

Standard External Beam Radiation Therapy is usually delivered in an outpatient setting, typically consisting of 28-45 treatments. Brachytherapy involves implanting radioactive seeds in the prostate using a needle, usually performed in the operating room. You may receive either therapies or a combination of both. Patients with high risk prostate cancer are candidates for adding hormonal therapy to the standard radiation therapy. Standard external beam radiation therapy treatment is painless, though some men experience side effects such as diarrhea, urinary symptoms and dry skin.

Novalis Tx™ Radiosurgery with SmartArc™ technology is a non-invasive surgical procedure that provides pinpoint accuracy in the treatment of a wide range of malignancies, including prostate cancer and other potentially debilitating conditions, without harming nearby healthy tissue.

The Novalis Tx uses extremely precise targeting to minimize radiation damage to normal tissue. Its beam is shaped to match the tumor itself and evenly distribute the radiation dose across the entire tumor at once. The Novalis Tx has the shortest treatment time available, 5 treatment sessions, and is generally a painless procedure this is performed on an outpatient basis. Please speak to your oncologist to find out if you are a candidate for Novalis Tx radiosurgery. For more information about Novalis, please visit www.southnassauradiosurgery.org or call 516-632-3360.

Active Surveillance (watchful waiting) may be an option recommended for patients with early-stage prostate cancer, particularly those who have low-grade tumors with only a small amount of cancer seen in the biopsy specimen. These patients have regular examinations, PSA testing, and sometimes scheduled biopsies. If there is evidence of cancer growth, active treatment may be recommended. Older patients and those with serious medical problems may also be good candidates for active surveillance.

How does a patient decide what the best treatment option is for localized prostate cancer?

Choosing a treatment option involves the patient, his family, and one or more doctors. They will need to consider the grade and stage of the cancer, the man's age and health, and his values and feelings about the potential benefits and risks of each treatment option. Often it is useful to seek additional opinions from physicians such as a urologist, radiation oncologist, an internist, family practitioner, or a medical oncologist.

Because there are several reasonable options for most patients, patients may hear different opinions and recommendations, and the decision may be difficult. However, patients should try to get as much information as possible and allow themselves enough time to make an informed decision.